Introduction a Cognitive Behavioral Therapeutic Package Based on Factors Affecting the Psychological Problems of bereaved Children

Millions of children around the world experience grief as a result of various events. However, the experience of grief after the death of a parent has the greatest negative impact on children and some of them, for various reasons, cannot adapt to the absence of parents and develop emotional behavioral problems such as anxiety disorders, depression, aggression, hyperactivity and academic problems. Researches has used several treatments for grief children that have somewhat reduced their problems But it is essential to use treatment appropriate to the needs and problems of children. The purpose of this study was to introduce a cognitive behavioral therapeutic package based on factors affecting the psychological problems of bereaved children.

The present research has been conducted qualitatively and in two ways: content analysis about interviews and thematic analysis about texts. The study population included mothers with grieving children, child therapists and books, published articles on grief in children. Ten mothers with grief children, 5 specialists in the field of grief children, and also internal and external books, dissertations and articles published and available from 1996 to 2020, were selected purposefully as the sample population. Data were collected through semi-structured interviews and literature review. Colaizzi Method was used to analyze the interview information. After listening to and implementing the recorded statements, the following meaningful statements related to the factors affecting the psychological problems of children after the absence of a parent were underlined and important sentences were identified. Basic concepts that represent an important part of onechr('39')s thinking were extracted and categorized based on similarity. Then they were linked together to create organizing concepts. Finally, were referred to the participants for confirmation of the factors obtained from the interviews. During the thematic analysis of the texts, first the meaningful sentences in books, articles and dissertations were underlined and named in the form of basic concepts. Finally, from several basic concepts that had a common theme, organizing themes were formed that covered the factors influencing the psychological problems of bereaved children.

Based on the coding of interviews with specialists and mothers as well as review of texts,  four organizing themes, including factors related to child, family, nature of death, and supportive factors were identified as the main factors affecting emotional behavior problems in grief children. Child-related factors were at the forefront of the factors identified in the formation of psychological problems of grief children, so these factors were given more attention in the treatment package and  were selected basic themes including expressing the childchr('39')s thoughts and feelings about the death and deceased parent; comparing a child with peers and feeling different from them; childchr('39')s level of understanding of the components of death; child coping strategies; the quality of the childchr('39')s relationship with the deceased parent, surviving parent, siblings, peers and teacher. Since family-related factors of the second category were identified as effective factors in the occurrence of emotional behavioral problems in children, in particular, the significant role that the surviving parent has in reducing or increasing the problems of children mourning after the loss, so this factor was also considered in the treatment package. Among the family-related factors were the conditions of intervention and training for the researcher, lack of awareness of surviving parent from childchr('39')s needs and problems after loss; and parenting styles of surviving parent, which were capable of modification, constituted the components of therapeutic package. Factors related to the nature of death and socio-supportive factors, because they could not be changed and manipulated by the researcher, despite their importance in causing problems for bereaved children, were not included in the treatment package. Cognitive-behavioral therapy package consists of 8 sessions of 45 minutes per week, the first to sixth sessions are for mourning children and the seventh and eighth sessions are for their mothers. Also, to evaluate the effectiveness of the mentioned treatment package, the Child Behavior Checklist can be used before and after the intervention.

Many causes can lead to or exacerbate psychological problems in bereaved children. Giving the opportunity to express emotions, informing the components of death on a cognitive level, and improving coping strategies and quality of childrenchr('39')s relationships with people around, also modifying parenting styles and informing surviving parent from the needs of children after a loss, all prevent the emotional behavior problems of grief children. Considering the centrality of child-related factors in the formation of psychological problems of bereaved children and the focus of treatment sessions on children, the results of this study can be used in schools, kindergartens, counseling centers and other situations that may be encountered by bereaved children. Because children who face any loss for various reasons, especially the loss of parents, need special attention from those around them. . In addition, therapists working in the field of children can use the results of the present study in educating families and surviving parents, as well as planning to treat the emotional behavioral problems of children affected by the death of parents and other missing persons.